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Seven ways to enhance a COPD pathway

Map of Medicine has systematically analysed the evidence on which changes to a pathway will reduce costs – without compromising quality and standards of care

Map of Medicine has systematically analysed the evidence on which changes to a pathway will reduce costs – without compromising quality and standards of care.

1 Ensure all GPs in your area give zanamivir or oseltamivir within 48 hours to people with COPD presenting with influenza-like illness when flu is circulating.1

Flu vaccinations for people with COPD aid both management and prevention of acute exacerbations of COPD.1,2 Treatment with zanamivir or oseltamivir is clinically and cost-effective.1

2 Encourage GPs to avoid prescribing inhaled steroids in people with mild COPD (FEV1 > 50%).1

Prescribing inhaled steroids for people with mild COPD is an unnecessary cost. A NICE review in 2010 showed inhaled steroids had no effect on exacerbation rates in patients with mild COPD.1

3 Advise GPs in your consortium to prescribe long-acting muscarinic antagonists (LAMAs) rather than short-acting muscarinic antagonists (SAMAs) to manage stable COPD.1

Treatment with LAMAs is as clinically effective and more cost-effective than treatment with SAMAs. Patients and carers strongly support the use of once-daily therapy, improving compliance.1

4 Arrange for all people with COPD on home oxygen therapy to have an annual assessment to see who no longer needs short-burst oxygen therapy (SBOT).2

Annual assessment for removal from therapy prevents inappropriate and ineffective prescriptions of SBOT. It is estimated that 75% of SBOT users will be removed from SBOT after clinical assessment, leading to savings of £645 per SBOT user removed.2

5 Ensure concentrators rather than cylinders* are prescribed for long-term oxygen therapy (LTOT) if more than three will be used per month1, or if two or more will be used per month for a year or longer.1

It is more cost-effective to prescribe a concentrator rather than cylinders* if more than three are being used per month, irrespective of the flow rate or duration of the prescription. It is always more cost-effective to prescribe a concentrator when two or more cylinders are being used per month and prescription is likely to last 12 months or longer; this is irrespective of the flow rate of the prescription.1 *A cylinder has a 1,360 litre capacity.

6 Arrange for quality-assured pulmonary rehabilitation to be provided to all people with COPD who have functional impairment.2

Pulmonary rehabilitation is cost-effective in the outpatient setting compared with usual care. There is currently an unmet need for pulmonary rehabilitation in a significant number of people with COPD and the potential savings for its use in patients with functional impairment are estimated at around £5.5m per year.3

7 Offer non-invasive ventilation to all people with COPD presenting with acute respiratory failure.3

NIV is cost-effective in people with a severe exacerbation of COPD, as it is more effective and less expensive than standard therapy alone.1 There is an estimated average net saving of £1.5m per year for the NHS by managing acute respiratory failure in people with COPD through the provision of NIV.2


The productivity considerations presented are specific to the UK. They were identified by systematically searching for, quality appraising and synthesising productivity evidence from multiple sources, including clinical practice guidelines, interventional procedure guidelines, health technology assessments, systematic reviews and evidence sourced from the NHS Economic Evaluation Database (NHS EED).

A productivity consideration explicitly states an action that can reduce the cost of care, while providing equivalent or improved patient outcomes, and is based on unequivocal clinical and economic evidence. Actions that are believed to lead to improved productivity, but for which there is not unequivocal clinical and economic evidence, are not included.

Some productivity considerations are informed by more recent evidence than that included in relevant national guidelines.

This document is not to be substituted for a healthcare professional's diagnosis or clinical decisions.

Copyright Map of Medicine

For further information go to

Seven ways to enhance a COPD pathway Seven ways to enhance a COPD pathway The savings at a glance

£1.5m - estimated annual average NHS saving of giving non-invasive ventilation to COPD patients presenting with acute respiratory failure

£5.5m - estimated annual saving of providing pulmonary rehabilitation to COPD patients with functional impairment

£645 for every patient removed from short-burst oxygen therapy - evidence suggests 75% of patients can be removed

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